MEDICARE: TERRY ELWOOD DUNN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171WH0202X	Home Modifications Contractor

General Provider Information

NPI Number	:	1720264070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRY ELWOOD DUNN

Provider Business Mailing Address
First Line	:	283 MOORES LN
Second Line	:
City	:	WEST PORTSMOUTH
State	:	OH
Zip	:	45663-8923
Country	:	US
Telephone Number	:	740-858-2576
Fax Number	:	740-858-9416

Provider Business Practice Location Address
First Line	:	283 MOORES LN
Second Line	:
City	:	WEST PORTSMOUTH
State	:	OH
Zip	:	45663-8923
Country	:	US
Telephone Number	:	740-858-2576
Fax Number	:	740-858-9416

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2008
Last Update Date	:	01/17/2008

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